en
×

分享给微信好友或者朋友圈

使用微信“扫一扫”功能。
通讯作者:

钱思轩,E-mail:qiansx@medmail.com.cn

中图分类号:R733.7

文献标识码:A

文章编号:1007-4368(2022)10-1349-08

DOI:10.7655/NYDXBNS20221001

参考文献 1
DE KOUCHKOVSKY I,ABDUL ⁃HAY M.Acute myeloid leukemia:a comprehensive review and 2016 update[J].Blood Cancer J,2016,6(7):e441
参考文献 2
NEWELL L F,COOK R J.Advances in acute myeloid leu⁃ kemia[J].BMJ,2021,375:n2026
参考文献 3
PAPAEMMANUIL E,GERSTUNG M,BULLINGER L,et al.Genomic classification and prognosis in acute myeloid leukemia[J].N Engl J Med,2016,374(23):2209-2221
参考文献 4
POLLYEA D A,PRATZ K,LETAI A,et al.Venetoclax with azacitidine or decitabine in patients with newly diag⁃ nosed acute myeloid leukemia:long term follow⁃up from a phase 1b study[J].Am J Hematol,2021,96(2):208-217
参考文献 5
HUANG J Y,HONG M,ZHU Y,et al.Decitabine in com⁃ bination with G⁃CSF,low⁃dose cytarabine and aclarubicin is as effective as standard dose chemotherapy in the in⁃ duction treatment for patients aged from 55 to 69 years old with newly diagnosed acute myeloid leukemia[J].Leuk Lymphoma,2018,59(11):2570-2579
参考文献 6
段丽敏,黄佳瑜,赵慧慧,等.DCAG治疗≥80岁的初诊急性髓系白血病患者疗效观察[J].南京医科大学学报(自然科学版),2017,37(1):105-108
参考文献 7
ZHANG W H,CHEN Y Q,PEI X H,et al.Effects of Decitabine on the proliferation of K562 cells and the ex⁃ pression of DR4 gene[J].Saudi J Biol Sci,2018,25(2):242-247
参考文献 8
CORY S,ROBERTS A W,COLMAN P M,et al.Target⁃ ing BCL ⁃ 2 ⁃like proteins to kill cancer cells[J].Trends Cancer,2016,2(8):443-460
参考文献 9
BHOLA P D,LETAI A.Mitochondria ⁃judges and execu⁃ tioners of cell death sentences[J].Mol Cell,2016,61(5):695-704
参考文献 10
PAN R Q,HOGDAL L J,BENITO J M,et al.Selective BCL⁃2 inhibition by ABT⁃199 causes on⁃target cell death in acute myeloid leukemia[J].Cancer Discov,2014,4(3):362-375
参考文献 11
WEI A H,MONTESINOS P,IVANOV V,et al.Veneto⁃ clax plus LDAC for newly diagnosed AML ineligible for intensive chemotherapy:a phase 3 randomized placebo ⁃ controlled trial[J].Blood,2020,135(24):2137-2145
参考文献 12
DINARDO C D,MAITI A,RAUSCH C R,et al.10⁃ day decitabine with venetoclax for newly diagnosed intensive chemotherapy ineligible,and relapsed or refractory acute myeloid leukaemia:a single⁃centre,phase 2 trial[J].Lan⁃ cet Haematol,2020,7(10):e724-e736
参考文献 13
ALDOSS I,YANG D Y,ARIBI A,et al.Efficacy of the combination of venetoclax and hypomethylating agents in relapsed/refractory acute myeloid leukemia[J].Haemato⁃logica,2018,103(9):e404-e407
参考文献 14
DINARDO C D,JONAS B A,PULLARKAT V,et al.Azacitidine and venetoclax in previously untreated acute myeloid leukemia[J].N Engl J Med,2020,383(7):617-629
参考文献 15
DINARDO C D,PRATZ K,PULLARKAT V,et al.Vene⁃ toclax combined with decitabine or azacitidine in treat⁃ ment⁃naive,elderly patients with acute myeloid leukemia [J].Blood,2019,133(1):7-17
参考文献 16
MAITI A,DINARDO C D,QIAO W,et al.Ten ⁃ day decitabine with venetoclax versus intensive chemotherapy in relapsed or refractory acute myeloid leukemia:a pro⁃ pensity score ⁃ matched analysis[J].Cancer,2021,127(22):4213-4220
参考文献 17
SONG B Q,WANG X,KONG X,et al.Clinical response to venetoclax and decitabine in acute promyelocytic leu⁃ kemia with a novel RARA⁃THRAP3 fusion:a case report [J].Front Oncol,2022,12:828852
参考文献 18
LIU M,ZHAO X J,PAN W J,et al.A novel HNRNPC ⁃ RARA fusion in acute promyelocytic leukaemia lacking PML⁃RARA rearrangement,sensitive to venetoclax⁃based therapy[J].Br J Haematol,2021,195(2):e123-e128
参考文献 19
LI Y L,YU J N,XU Q H,et al.Relapsed/refractory acute promyelocytic leukemia with RARA⁃LBD region mutation was salvaged by venetoclax:a case report[J].Medicine,2021,100(48):28076
参考文献 20
ESTELLER M.Epigenetics in cancer[J].N Engl J Med,2008,358(11):1148-1159
参考文献 21
PALII S S,VAN EMBURGH B O,SANKPAL U T,et al.DNA methylation inhibitor 5⁃Aza⁃2′⁃deoxycytidine induc⁃ es reversible genome⁃wide DNA damage that is distinctly influenced by DNA methyltransferases 1 and 3B[J].Mol Cell Biol,2008,28(2):752-771
参考文献 22
PANG B X,QIAO X H,JANSSEN L,et al.Drug⁃induced histone eviction from open chromatin contributes to the chemotherapeutic effects of doxorubicin[J].Nat Com⁃ mun,2013,4:1908
参考文献 23
QIAO X H,VAN DER ZANDEN S Y,WANDER D P A,et al.Uncoupling DNA damage from chromatin damage to detoxify doxorubicin[J].PNAS,2020,117(26):15182-15192
参考文献 24
IIHOSHI H,ISHIHARA T,KURODA S,et al.Aclarubi⁃ cin,an anthracycline anti⁃cancer drug,fluorescently con⁃ trasts mitochondria and reduces the oxygen consumption rate in living human cells[J].Toxicol Lett,2017,277:109-114
参考文献 25
FANDY T E,JIEMJIT A,THAKAR M,et al.Decitabine induces delayed reactive oxygen species(ROS)accumu⁃ lation in leukemia cells and induces the expression of ROS generating enzymes[J].Clin Cancer Res,2014,20(5):1249-1258
参考文献 26
LI L Z,LIU W J,SUN Q,et al.Decitabine downregulates TIGAR to induce apoptosis and autophagy in myeloid leu⁃ kemia cells[J].Oxidative Med Cell Longev,2021,2021:8877460
参考文献 27
NGUYEN L X T,TROADEC E,KALVALA A,et al.The Bcl⁃2 inhibitor venetoclax inhibits Nrf2 antioxidant path⁃ way activation induced by hypomethylating agents in AML [J].J Cell Physiol,2019,234(8):14040-14049
参考文献 28
NIU X,WANG G,WANG Y,et al.Acute myeloid leuke⁃ mia cells harboring MLL fusion genes or with the acute promyelocytic leukemia phenotype are sensitive to the Bcl⁃ 2 ⁃ selective inhibitor ABT ⁃ 199[J].Leukemia,2014,28(7):1557-1560
参考文献 29
KONTRO M,KUMAR A,MAJUMDER M M,et al.HOX gene expression predicts response to BCL⁃2 inhibition in acute myeloid leukemia[J].Leukemia,2017,31(2):301-309
目录contents

    摘要

    目的:观察维奈克拉(venetoclax,ABT-199)联合地西他滨(decitabine,DAC)、阿柔比星(aclarubicin,ACM)对急性髓系白血病(acute myeloid leukemia,AML)细胞株HL60、KG-1细胞增殖和凋亡的影响。方法:CCK-8法检测不同浓度ABT-199、 DAC、ACM单药及ABT-199+DAC、ABT-199+ACM、ABT-199+ACM+DAC 3种药物联合方式对HL60、KG-1细胞增殖的影响,使用 Compusyn软件分析药物联合是否具有协同作用;流式细胞术检测上述单药及药物联合对HL60、KG-1细胞凋亡比例和细胞周期分布的影响。结果:ABT-199、DAC、ACM单药均抑制HL60、KG-1细胞增殖。相比单药ABT-199,3种药物联合方式均显著增强对HL60、KG-1细胞增殖的抑制作用,且均具有协同作用。ABT-199联合用药明显促进HL60、KG-1细胞凋亡。DAC、ABT- 199+DAC、ABT-199+ACM+DAC可促使HL60、KG-1细胞周期阻滞于G2/S期。结论:ABT-199联合DAC、ACM抑制AML细胞增殖且具有协同作用,可促进AML细胞凋亡和细胞周期阻滞。

    Abstract

    Objective:To investigate the effects of venetoclax(ABT-199)combined with decitabine(DAC)and/or aclarubicin(ACM) on the proliferation and apoptosis of acute myeloid leukemia(AML)cell lines(HL60 and KG -1). Methods:HL60 and KG -1 were treated with different concentrations of ABT-199,DAC,ACM,ABT-199+DAC,ABT-199+ACM and ABT-199+ACM+DAC. The cell proliferation was determined by CCK-8 method. Compusyn software was used to analyze whether the drug combinations had synergistic effect. The apoptosis and cell cycle were detected by flow cytometry(FCM). Results:ABT-199,DAC and ACM inhibited the growth of HL60 and KG -1 respectively. The three ways of drug combinations significantly inhibited the cell proliferation of HL60 and KG -1, compared with ABT - 199 alone,and all had synergistic effect. The combinations of ABT - 199 significantly induced the apoptosis of HL60 and KG-1. The cell cycle was arrested at G2/S phase in HL60 and KG-1 cells treated by DAC,the combination of ABT-199 and DAC,or the combination of ABT-199,ACM and DAC. Conclusion:ABT-199 combinations significantly inhibited the proliferation of AML cell lines and had synergistic effect. ABT-199 combined with ACM and DAC promoted the apoptosis and arrested the cell cycle of AML cells.

  • 急性髓系白血病(acute myeloid leukemia,AML) 是我国成人白血病中最常见的类型,在临床及遗传学上具有较强的异质性。标准剂量阿糖胞苷联合蒽环类药物的诱导方案明显改善了年轻AML患者的预后,而老年AML患者的预后尚未显著改善[1-3]。维奈克拉(venetoclax,ABT⁃199)通过结合抗凋亡蛋白BCL⁃2促进细胞凋亡,对AML细胞有一定增殖抵抗作用,但同时需要联合其他药物治疗才能获得更深的缓解作用。地西他滨(decitabine,DAC)是一种胞苷类似物,属于去甲基化药物。较低药物浓度的地西他滨可抑制DNA甲基转移酶,逆转DNA甲基化状态,抑制肿瘤细胞增殖,诱导肿瘤细胞凋亡。阿柔比星(aclarubicin,ACM)是一种蒽环类抗肿瘤药物,通过抑制DNA拓扑异构酶Ⅱ可干扰染色质的功能,同时影响线粒体功能。

  • 多项临床试验证明ABT⁃199联合去甲基化药物治疗初诊老年AML、复发难治性AML可显著改善患者预后[4]。DAC联合ACM的方案(如DCAG)治疗老年初诊AML患者1个疗程后的完全缓解(CR) 率达64.7%,明显改善老年AML患者的预后[5-6]。鉴于ABT⁃199、DAC、ACM在AML中显著的治疗作用且可耐受,本研究将探索ABT ⁃199联合DAC、 ACM对AML细胞增殖和凋亡的影响,为临床治疗AML提供基本理论依据。

  • 1 材料和方法

  • 1.1 材料

  • 人AML细胞株HL60、KG⁃1细胞(上海中乔新舟生物科技有限公司);药物ABT ⁃ 199、DAC、ACM (MCE公司,美国);IMDM培养液、胎牛血清(Gibco公司,美国);CCK⁃8试剂盒(同仁化学试剂研究所,日本);细胞凋亡检测试剂盒(南京诺唯赞公司);细胞周期检测试剂盒(杭州联科生物公司)。

  • 1.2 方法

  • 1.2.1 细胞培养

  • 人AML细胞株HL60、KG⁃1细胞培养于含10%胎牛血清的IMDM培养液中,置于37℃、5%CO2、饱和湿度培养箱中培养,隔天换液,实验时取对数生长期的细胞。

  • 1.2.2 CCK⁃8实验

  • 稀释不同浓度药物与细胞混合,使细胞终密度为2×105 个/mL。将细胞接种于96孔板,每孔体系为100 μL,同时设立空白组和对照组,每组3个复孔, 96孔板四周加入PBS,置于细胞培养箱中培养。72h后在每孔中加入10 μL CCK⁃8溶液,注意防止产生气泡,避光孵育2h后用酶标仪测定450nm处的吸光度,计算细胞生长抑制率。

  • 1.2.3 细胞凋亡实验

  • 分别收集对照组和实验组1×106 个细胞,用预冷的PBS洗涤细胞2次,弃上清,加入100 μL Binding Buffer重悬细胞。加入5 μL Annexin V⁃FITC和5 μL PI,轻轻吹匀,避光孵育10min后加入400 μL Binding Buffer,轻轻混匀。染色后样品在1h内用流式细胞仪检测。Annexin V-/PI-为活细胞,Annexin V+/PI-为早期凋亡细胞,Annexin V+/PI+ 为晚期凋亡细胞。

  • 1.2.4 细胞周期实验

  • 分别收集对照组和实验组1×106 个细胞,离心,弃上清,加入1mL室温下的PBS,将细胞悬液缓慢加至3mL预冷的无水乙醇中,-20℃固定过夜。检测当天将固定细胞离心,弃乙醇,加入3mL室温下的PBS,放置15min使细胞水化。离心,弃上清,加入1mL DNA染色液,涡旋振荡10s混匀。室温避光孵育30min。选择最低上样速度,在流式细胞仪上进行检测。

  • 1.3 统计学方法

  • 所有实验至少重复3次。计量资料用均数±标准差(x-±s)表示。采用GraphPad Prism 8软件分析数据和制作统计图。两组间比较采用t检验或单因素方差分析。采用Compusyn软件分析药物联合使用的效果,联合指数CI< 1表示协同作用,CI=1表示相加作用,CI> 1表示拮抗作用。P< 0.05为差异有统计学意义。

  • 2 结果

  • 2.1 单药ABT⁃199、DAC、ACM对AML细胞增殖的抑制作用

  • 不同浓度的ABT⁃199、DAC、ACM分别作用于AML细胞(HL60、KG⁃1),72h后检测3种药物对两株细胞增殖的抑制作用。结果显示在一定的浓度范围里,随着药物浓度升高,细胞增殖抑制率也增高。HL60细胞对ABT⁃199相对敏感,KG⁃1细胞对DAC相对敏感,两种细胞对ACM都比较敏感。如图1所示,在HL60细胞中,ABT⁃199(20~80nmol/L) 作用72h后,细胞增殖抑制率为30.58%~60.30%;而在KG⁃1细胞中,ABT⁃199(200~800nmol/L)作用72h后,细胞增殖抑制率为33.53%~52.66%。在HL60细胞中,DAC(2 000~8 000nmol/L)作用72h后,细胞增殖抑制率为26.14%~44.39%;在KG ⁃1细胞中, DAC(50~200nmol/L)作用72h后,细胞增殖抑制率为38.42%~62.20%。ACM(8~32nmol/L)分别作用HL60、 KG ⁃ 1细胞72h后,细胞增殖抑制率为11.02%~48.95%、29.88%~67.61%。

  • 2.2 ABT⁃199联合用药显著增强对AML细胞增殖的抑制作用,且具有协同作用

  • 在上述单药研究的基础上,我们观察了ABT⁃199联合DAC、ACM作用72h对两种细胞增殖的抑制作用。如图2所示,第1种药物联合方式是ABT⁃199+ ACM,在HL60、KG⁃1中药物比例分别为20∶8、200∶ 8;第2种药物联合方式是ABT⁃199+DAC,在HL60、 KG⁃1中药物比例分别为20∶2 000、200∶50;第3种药物联合方式是ABT⁃199+ACM+DAC,在HL60、 KG⁃1中药物比例分别为20∶8∶2 000、200∶8∶50。结果提示,3种药物联合方式对两种细胞的增殖均有明显的抑制作用。相比单用ABT⁃199,联合用药可显著增强抗AML细胞增殖的作用(P< 0.05)。通过计算药物联合指数CI,可见3种药物联合方式的CI值均< 1,如图3所示,表明在两株细胞系中,3种药物联合方式均具有协同作用,其中ABT⁃199+DAC的协同作用最强,其次是ABT⁃199+ ACM+DAC。

  • 2.3 ABT⁃199联合用药明显促进AML细胞凋亡

  • 流式细胞术检测结果如图4所示,ABT⁃199+ACM组、ABT⁃199+DAC组、ABT⁃199+ACM+DAC组HL60细胞凋亡率分别为[(24.22±4.17)%、(21.40±2.26)%、 (26.74±3.20)%],较ABT⁃199单药组[(14.67±1.35)%] 差异有统计学意义(均P< 0.05)。同样,ABT⁃199+ ACM组、ABT⁃199+DAC组、ABT⁃199+ACM+DAC组KG⁃1细胞凋亡率分别为[(30.18±3.50)%、(14.62± 0.84)%、(32.79 ± 2.56)%],较ABT ⁃ 199单药组 [(10.55±0.69)%]差异有统计学意义(均P< 0.05)。实验证明ABT⁃199联合用药明显促进AML细胞凋亡,细胞凋亡可能是3种药物联合发挥协同抗肿瘤的途径之一。有文献报道DAC作用于AML细胞后,使其重新表达DR4诱导细胞凋亡[7],这可能是ABT⁃199联合DAC促进AML细胞凋亡的部分原因。

  • 图1 ABT⁃199、DAC、ACM单药对HL60、KG⁃1细胞增殖的影响

  • Fig.1 The effects of ABT⁃199,DAC,ACM on the proliferation of HL60and KG⁃1cells

  • 图2 ABT⁃199联合用药对HL60、KG⁃1细胞增殖的影响

  • Fig.2 The effects of ABT⁃199combinations on the proliferation of HL60and KG⁃1cells

  • 图3 ABT⁃199联合用药作用于HL60、KG⁃1细胞的CI指数图

  • Fig.3 The combination index figures of ABT⁃199combinations on the HL60,KG⁃1

  • 2.4 ABT⁃199联合用药对AML细胞周期的影响

  • 为了探索ABT ⁃199联合DAC、ACM对HL60、 KG⁃ 1细胞周期的影响,分别用ABT ⁃ 199、ACM、 DAC、ABT ⁃ 199+ACM、ABT ⁃ 199+DAC、ABT ⁃ 199+ ACM+DAC处理HL60、KG⁃1细胞72h后用流式细胞术检测细胞周期分布。如图5所示,DAC使HL60细胞阻滞在G2期(细胞比例从16.07%增加至27.7%, P< 0.01),KG⁃1细胞阻滞在G2/S期(G2期的比例从17.47%增加至34.6%,P< 0.01;S期的比例从30.8%增加至48.73%,P< 0.001);ABT⁃199+DAC组促使HL60细胞阻滞在S期(细胞比例从39.23%增加至46.47%,P< 0.05),KG⁃1细胞阻滞在G2/S期(G2期的比例从17.47%增加至29.57%,P< 0.05;S期的比例从30.8%增加至51.0%,P< 0.001);ABT ⁃ 199+ ACM+DAC使HL60细胞阻滞在G2期(细胞比例从16.07%增加至22.30%,P< 0.01),KG⁃1细胞阻滞在S期(细胞比例从30.80%增加至47.4%,P< 0.01)。可见3种药物中只有DAC影响AML细胞周期,阻滞的细胞周期位置与细胞种类及联合的药物有关。

  • 3 讨论

  • BCL⁃2蛋白家族通过控制线粒体外膜通透性决定细胞是否发生凋亡,这与调节促凋亡蛋白和抗凋亡蛋白的功能平衡有关。研究发现BCL⁃2抑制剂ABT ⁃199可特异性结合抗凋亡蛋白BCL ⁃2,释放BIM、BAX等促凋亡蛋白,继而引发肿瘤细胞凋亡[8]。其中,ABT⁃199在治疗血液系统恶性肿瘤中发挥着重要作用,包括AML、慢性淋巴细胞白血病、非霍奇金淋巴瘤、急性淋巴细胞白血病、多发性骨髓瘤、骨髓增生异常综合征等[9-10]。2018年美国食品与药品管理局(FDA)批准ABT ⁃ 199联合去甲基化药物 (HMA)或小剂量阿糖胞苷(LDAC)用于治疗初诊老年或不能耐受高强度化疗的AML患者。2020年我国国家药品监督管理局(NMPA)批准ABT⁃199联合阿扎胞苷(AZA)用于治疗年龄≥75岁或因合并疾病不适合接受强诱导化疗的AML患者。多项研究表明,以ABT⁃199为基础的治疗方案在不适合强化疗的老年AML及复发难治AML患者中显示了良好的疗效和可耐受的安全性[11-13]。一项Ⅲ期临床试验表明,对于不能耐受标准化疗的初治AML患者采用ABT⁃199联合AZA治疗具有显著的疗效[14]。相比安慰剂联合AZA,ABT⁃199联合AZA明显延长了中位生存时间和中位缓解持续时间,显著提高了不同基因突变亚组的缓解率,包括IDH1/2突变、FLT3突变、NPM1突变、TP53突变。同样,DiNardo等[15] 报道了ABT ⁃ 199联合HMA(DAC或AZA)治疗高危AML缓解率较高,包括年龄≥75岁、不良遗传学改变、继发性AML。Maiti等[16] 回顾性对比ABT⁃199联合10d DAC与强化疗方案治疗复发难治AML的疗效,前者缓解率更高,总生存时间更长。另外,有文献报道采用ABT⁃199单药或联合去甲基化药物能够挽救治疗变异型急性早幼粒细胞性白血病(APL),包括含有RARA⁃THRAP3、HNRNPC⁃RARA融合基因或RARA⁃LBD突变的APL[17-19]。综上所述,ABT⁃ 199为临床治疗老年或不能耐受强化疗或复发难治的AML及维甲酸(ATRA)耐药的变异型APL患者提供更多的选择性。

  • 图4 ABT⁃199联合用药对HL60、KG⁃1细胞凋亡的影响

  • Fig.4 The effects of ABT⁃199combinations on the apoptosis of HL60and KG⁃1cells

  • 图5 ABT⁃199联合用药对HL60、KG⁃1细胞周期分布的影响

  • Fig.5 The effects of ABT⁃199combinations on the HL60and KG⁃1cell circle distrabution

  • 很多肿瘤细胞具有异常甲基化状态,这与肿瘤的发生发展密切相关[20]。DAC是一种核苷类似物,低浓度时抑制DNA甲基转移酶,引起启动子去甲基化、组蛋白修饰,使沉默的抑癌基因重新表达,抑制肿瘤细胞增殖,诱导细胞凋亡。高浓度时直接损伤DNA,导致细胞死亡[21]。ACM属于Ⅱ型拓扑异构酶抑制剂,主要通过嵌入DNA链阻止拓扑异构酶Ⅱ与DNA结合,导致染色质损伤、多种组蛋白从基因组特定区域脱落,从而引起表观遗传基因、 DNA损伤应答信号及细胞凋亡的改变。此外, ACM还可以通过影响线粒体呼吸功能而发挥细胞毒作用。ACM目前用于临床治疗AML、淋巴瘤、乳腺癌等[22-24]

  • 以上3种药物不同的抗白血病机制可能是药物联合使用抑制细胞增殖产生协同作用的重要原因。有文献报道ABT⁃199联合DAC可使AML细胞产生线粒体活性氧增加,这可能是药物联用发挥协同抗白血病作用的机制之一[25-27]。本研究结果显示,低浓度的ACM对两种细胞都比较敏感,但是不同细胞类型对ABT⁃199、DAC敏感性是不同的,这可能与细胞间不同的遗传学改变有关。已有研究证明ABT⁃199对具有某些遗传改变的AML细胞显现出较强的抗肿瘤活性,如MLL重排、IDH1/2或NPM1突变、HOX高表达。多项研究指出ABT⁃199的敏感性一般与AML细胞表达BCL⁃2蛋白含量无关,而与BCL⁃2/MCL⁃1、BCL⁃2/BCL⁃XL转录比值正相关[28-29]。本研究观察到ABT⁃199、ACM对细胞周期分布几乎没有影响,而DAC具有阻滞细胞周期的功能。细胞周期停滞可能导致细胞损伤无法修复,进而发生细胞凋亡。药物联合使用将增加抗白血病细胞谱,降低单药使用剂量,减少药物累积毒性,这对于治疗AML起着重要作用。

  • ABT⁃199和DAC作为小分子靶向药物对正常细胞具有较小的毒性作用,ACM与其他蒽环类药物相比,具有较小的心脏毒性,因此3种药物联合治疗老年AML具有安全和可耐受的优点。综上所述,本研究在细胞水平上证明了ABT⁃199联合ACM、DAC具有协同作用,但需进一步在临床实践中观察其有效性和安全性。

  • 参考文献

    • [1] DE KOUCHKOVSKY I,ABDUL ⁃HAY M.Acute myeloid leukemia:a comprehensive review and 2016 update[J].Blood Cancer J,2016,6(7):e441

    • [2] NEWELL L F,COOK R J.Advances in acute myeloid leu⁃ kemia[J].BMJ,2021,375:n2026

    • [3] PAPAEMMANUIL E,GERSTUNG M,BULLINGER L,et al.Genomic classification and prognosis in acute myeloid leukemia[J].N Engl J Med,2016,374(23):2209-2221

    • [4] POLLYEA D A,PRATZ K,LETAI A,et al.Venetoclax with azacitidine or decitabine in patients with newly diag⁃ nosed acute myeloid leukemia:long term follow⁃up from a phase 1b study[J].Am J Hematol,2021,96(2):208-217

    • [5] HUANG J Y,HONG M,ZHU Y,et al.Decitabine in com⁃ bination with G⁃CSF,low⁃dose cytarabine and aclarubicin is as effective as standard dose chemotherapy in the in⁃ duction treatment for patients aged from 55 to 69 years old with newly diagnosed acute myeloid leukemia[J].Leuk Lymphoma,2018,59(11):2570-2579

    • [6] 段丽敏,黄佳瑜,赵慧慧,等.DCAG治疗≥80岁的初诊急性髓系白血病患者疗效观察[J].南京医科大学学报(自然科学版),2017,37(1):105-108

    • [7] ZHANG W H,CHEN Y Q,PEI X H,et al.Effects of Decitabine on the proliferation of K562 cells and the ex⁃ pression of DR4 gene[J].Saudi J Biol Sci,2018,25(2):242-247

    • [8] CORY S,ROBERTS A W,COLMAN P M,et al.Target⁃ ing BCL ⁃ 2 ⁃like proteins to kill cancer cells[J].Trends Cancer,2016,2(8):443-460

    • [9] BHOLA P D,LETAI A.Mitochondria ⁃judges and execu⁃ tioners of cell death sentences[J].Mol Cell,2016,61(5):695-704

    • [10] PAN R Q,HOGDAL L J,BENITO J M,et al.Selective BCL⁃2 inhibition by ABT⁃199 causes on⁃target cell death in acute myeloid leukemia[J].Cancer Discov,2014,4(3):362-375

    • [11] WEI A H,MONTESINOS P,IVANOV V,et al.Veneto⁃ clax plus LDAC for newly diagnosed AML ineligible for intensive chemotherapy:a phase 3 randomized placebo ⁃ controlled trial[J].Blood,2020,135(24):2137-2145

    • [12] DINARDO C D,MAITI A,RAUSCH C R,et al.10⁃ day decitabine with venetoclax for newly diagnosed intensive chemotherapy ineligible,and relapsed or refractory acute myeloid leukaemia:a single⁃centre,phase 2 trial[J].Lan⁃ cet Haematol,2020,7(10):e724-e736

    • [13] ALDOSS I,YANG D Y,ARIBI A,et al.Efficacy of the combination of venetoclax and hypomethylating agents in relapsed/refractory acute myeloid leukemia[J].Haemato⁃logica,2018,103(9):e404-e407

    • [14] DINARDO C D,JONAS B A,PULLARKAT V,et al.Azacitidine and venetoclax in previously untreated acute myeloid leukemia[J].N Engl J Med,2020,383(7):617-629

    • [15] DINARDO C D,PRATZ K,PULLARKAT V,et al.Vene⁃ toclax combined with decitabine or azacitidine in treat⁃ ment⁃naive,elderly patients with acute myeloid leukemia [J].Blood,2019,133(1):7-17

    • [16] MAITI A,DINARDO C D,QIAO W,et al.Ten ⁃ day decitabine with venetoclax versus intensive chemotherapy in relapsed or refractory acute myeloid leukemia:a pro⁃ pensity score ⁃ matched analysis[J].Cancer,2021,127(22):4213-4220

    • [17] SONG B Q,WANG X,KONG X,et al.Clinical response to venetoclax and decitabine in acute promyelocytic leu⁃ kemia with a novel RARA⁃THRAP3 fusion:a case report [J].Front Oncol,2022,12:828852

    • [18] LIU M,ZHAO X J,PAN W J,et al.A novel HNRNPC ⁃ RARA fusion in acute promyelocytic leukaemia lacking PML⁃RARA rearrangement,sensitive to venetoclax⁃based therapy[J].Br J Haematol,2021,195(2):e123-e128

    • [19] LI Y L,YU J N,XU Q H,et al.Relapsed/refractory acute promyelocytic leukemia with RARA⁃LBD region mutation was salvaged by venetoclax:a case report[J].Medicine,2021,100(48):28076

    • [20] ESTELLER M.Epigenetics in cancer[J].N Engl J Med,2008,358(11):1148-1159

    • [21] PALII S S,VAN EMBURGH B O,SANKPAL U T,et al.DNA methylation inhibitor 5⁃Aza⁃2′⁃deoxycytidine induc⁃ es reversible genome⁃wide DNA damage that is distinctly influenced by DNA methyltransferases 1 and 3B[J].Mol Cell Biol,2008,28(2):752-771

    • [22] PANG B X,QIAO X H,JANSSEN L,et al.Drug⁃induced histone eviction from open chromatin contributes to the chemotherapeutic effects of doxorubicin[J].Nat Com⁃ mun,2013,4:1908

    • [23] QIAO X H,VAN DER ZANDEN S Y,WANDER D P A,et al.Uncoupling DNA damage from chromatin damage to detoxify doxorubicin[J].PNAS,2020,117(26):15182-15192

    • [24] IIHOSHI H,ISHIHARA T,KURODA S,et al.Aclarubi⁃ cin,an anthracycline anti⁃cancer drug,fluorescently con⁃ trasts mitochondria and reduces the oxygen consumption rate in living human cells[J].Toxicol Lett,2017,277:109-114

    • [25] FANDY T E,JIEMJIT A,THAKAR M,et al.Decitabine induces delayed reactive oxygen species(ROS)accumu⁃ lation in leukemia cells and induces the expression of ROS generating enzymes[J].Clin Cancer Res,2014,20(5):1249-1258

    • [26] LI L Z,LIU W J,SUN Q,et al.Decitabine downregulates TIGAR to induce apoptosis and autophagy in myeloid leu⁃ kemia cells[J].Oxidative Med Cell Longev,2021,2021:8877460

    • [27] NGUYEN L X T,TROADEC E,KALVALA A,et al.The Bcl⁃2 inhibitor venetoclax inhibits Nrf2 antioxidant path⁃ way activation induced by hypomethylating agents in AML [J].J Cell Physiol,2019,234(8):14040-14049

    • [28] NIU X,WANG G,WANG Y,et al.Acute myeloid leuke⁃ mia cells harboring MLL fusion genes or with the acute promyelocytic leukemia phenotype are sensitive to the Bcl⁃ 2 ⁃ selective inhibitor ABT ⁃ 199[J].Leukemia,2014,28(7):1557-1560

    • [29] KONTRO M,KUMAR A,MAJUMDER M M,et al.HOX gene expression predicts response to BCL⁃2 inhibition in acute myeloid leukemia[J].Leukemia,2017,31(2):301-309

  • 参考文献

    • [1] DE KOUCHKOVSKY I,ABDUL ⁃HAY M.Acute myeloid leukemia:a comprehensive review and 2016 update[J].Blood Cancer J,2016,6(7):e441

    • [2] NEWELL L F,COOK R J.Advances in acute myeloid leu⁃ kemia[J].BMJ,2021,375:n2026

    • [3] PAPAEMMANUIL E,GERSTUNG M,BULLINGER L,et al.Genomic classification and prognosis in acute myeloid leukemia[J].N Engl J Med,2016,374(23):2209-2221

    • [4] POLLYEA D A,PRATZ K,LETAI A,et al.Venetoclax with azacitidine or decitabine in patients with newly diag⁃ nosed acute myeloid leukemia:long term follow⁃up from a phase 1b study[J].Am J Hematol,2021,96(2):208-217

    • [5] HUANG J Y,HONG M,ZHU Y,et al.Decitabine in com⁃ bination with G⁃CSF,low⁃dose cytarabine and aclarubicin is as effective as standard dose chemotherapy in the in⁃ duction treatment for patients aged from 55 to 69 years old with newly diagnosed acute myeloid leukemia[J].Leuk Lymphoma,2018,59(11):2570-2579

    • [6] 段丽敏,黄佳瑜,赵慧慧,等.DCAG治疗≥80岁的初诊急性髓系白血病患者疗效观察[J].南京医科大学学报(自然科学版),2017,37(1):105-108

    • [7] ZHANG W H,CHEN Y Q,PEI X H,et al.Effects of Decitabine on the proliferation of K562 cells and the ex⁃ pression of DR4 gene[J].Saudi J Biol Sci,2018,25(2):242-247

    • [8] CORY S,ROBERTS A W,COLMAN P M,et al.Target⁃ ing BCL ⁃ 2 ⁃like proteins to kill cancer cells[J].Trends Cancer,2016,2(8):443-460

    • [9] BHOLA P D,LETAI A.Mitochondria ⁃judges and execu⁃ tioners of cell death sentences[J].Mol Cell,2016,61(5):695-704

    • [10] PAN R Q,HOGDAL L J,BENITO J M,et al.Selective BCL⁃2 inhibition by ABT⁃199 causes on⁃target cell death in acute myeloid leukemia[J].Cancer Discov,2014,4(3):362-375

    • [11] WEI A H,MONTESINOS P,IVANOV V,et al.Veneto⁃ clax plus LDAC for newly diagnosed AML ineligible for intensive chemotherapy:a phase 3 randomized placebo ⁃ controlled trial[J].Blood,2020,135(24):2137-2145

    • [12] DINARDO C D,MAITI A,RAUSCH C R,et al.10⁃ day decitabine with venetoclax for newly diagnosed intensive chemotherapy ineligible,and relapsed or refractory acute myeloid leukaemia:a single⁃centre,phase 2 trial[J].Lan⁃ cet Haematol,2020,7(10):e724-e736

    • [13] ALDOSS I,YANG D Y,ARIBI A,et al.Efficacy of the combination of venetoclax and hypomethylating agents in relapsed/refractory acute myeloid leukemia[J].Haemato⁃logica,2018,103(9):e404-e407

    • [14] DINARDO C D,JONAS B A,PULLARKAT V,et al.Azacitidine and venetoclax in previously untreated acute myeloid leukemia[J].N Engl J Med,2020,383(7):617-629

    • [15] DINARDO C D,PRATZ K,PULLARKAT V,et al.Vene⁃ toclax combined with decitabine or azacitidine in treat⁃ ment⁃naive,elderly patients with acute myeloid leukemia [J].Blood,2019,133(1):7-17

    • [16] MAITI A,DINARDO C D,QIAO W,et al.Ten ⁃ day decitabine with venetoclax versus intensive chemotherapy in relapsed or refractory acute myeloid leukemia:a pro⁃ pensity score ⁃ matched analysis[J].Cancer,2021,127(22):4213-4220

    • [17] SONG B Q,WANG X,KONG X,et al.Clinical response to venetoclax and decitabine in acute promyelocytic leu⁃ kemia with a novel RARA⁃THRAP3 fusion:a case report [J].Front Oncol,2022,12:828852

    • [18] LIU M,ZHAO X J,PAN W J,et al.A novel HNRNPC ⁃ RARA fusion in acute promyelocytic leukaemia lacking PML⁃RARA rearrangement,sensitive to venetoclax⁃based therapy[J].Br J Haematol,2021,195(2):e123-e128

    • [19] LI Y L,YU J N,XU Q H,et al.Relapsed/refractory acute promyelocytic leukemia with RARA⁃LBD region mutation was salvaged by venetoclax:a case report[J].Medicine,2021,100(48):28076

    • [20] ESTELLER M.Epigenetics in cancer[J].N Engl J Med,2008,358(11):1148-1159

    • [21] PALII S S,VAN EMBURGH B O,SANKPAL U T,et al.DNA methylation inhibitor 5⁃Aza⁃2′⁃deoxycytidine induc⁃ es reversible genome⁃wide DNA damage that is distinctly influenced by DNA methyltransferases 1 and 3B[J].Mol Cell Biol,2008,28(2):752-771

    • [22] PANG B X,QIAO X H,JANSSEN L,et al.Drug⁃induced histone eviction from open chromatin contributes to the chemotherapeutic effects of doxorubicin[J].Nat Com⁃ mun,2013,4:1908

    • [23] QIAO X H,VAN DER ZANDEN S Y,WANDER D P A,et al.Uncoupling DNA damage from chromatin damage to detoxify doxorubicin[J].PNAS,2020,117(26):15182-15192

    • [24] IIHOSHI H,ISHIHARA T,KURODA S,et al.Aclarubi⁃ cin,an anthracycline anti⁃cancer drug,fluorescently con⁃ trasts mitochondria and reduces the oxygen consumption rate in living human cells[J].Toxicol Lett,2017,277:109-114

    • [25] FANDY T E,JIEMJIT A,THAKAR M,et al.Decitabine induces delayed reactive oxygen species(ROS)accumu⁃ lation in leukemia cells and induces the expression of ROS generating enzymes[J].Clin Cancer Res,2014,20(5):1249-1258

    • [26] LI L Z,LIU W J,SUN Q,et al.Decitabine downregulates TIGAR to induce apoptosis and autophagy in myeloid leu⁃ kemia cells[J].Oxidative Med Cell Longev,2021,2021:8877460

    • [27] NGUYEN L X T,TROADEC E,KALVALA A,et al.The Bcl⁃2 inhibitor venetoclax inhibits Nrf2 antioxidant path⁃ way activation induced by hypomethylating agents in AML [J].J Cell Physiol,2019,234(8):14040-14049

    • [28] NIU X,WANG G,WANG Y,et al.Acute myeloid leuke⁃ mia cells harboring MLL fusion genes or with the acute promyelocytic leukemia phenotype are sensitive to the Bcl⁃ 2 ⁃ selective inhibitor ABT ⁃ 199[J].Leukemia,2014,28(7):1557-1560

    • [29] KONTRO M,KUMAR A,MAJUMDER M M,et al.HOX gene expression predicts response to BCL⁃2 inhibition in acute myeloid leukemia[J].Leukemia,2017,31(2):301-309

  • 通知关闭
    郑重声明